Dream of dignity collides with reality

John Beraglia, seen in a 2001 police photo, bounced among South Florida State Hospital, the streets and jail over a 20-year period, before dying in law enforcement custody.

John Beraglia, seen in a 2001 police photo, bounced among South Florida State Hospital, the streets and jail over a 20-year period, before dying in law enforcement custody.

South Florida Sun-Sentinel Editorial Board

Being mentally ill is not a crime, but it can get you arrested. It can get you thrown in jail and keep you confined for months in a terrifying place that does nothing to improve your mental health. Once released, unless you're one of the lucky ones, you're likely to repeat that pattern again and again.

In South Florida in the 21st century, it shouldn't be this way. Things were supposed to be so much better by now.

There was a time, of course, when things were so much worse. Not all that long ago, mental institutions in Florida and around the United States were snake pits of abuse, neglect and wasted lives. That changed with the deinstitutionalization movement of the latter 20th century, which moved most of the mentally ill out of institutions and into the community, where they were supposed to find an array of community-based mental health services.

It was to be the new age of mental health treatment: humane, non-restrictive and, thanks to modern drugs, effective. Reformers had visions of the mentally ill, even those with severe and persistent conditions, living and working in the community as fully productive members of society.

The reformers have had some success, to be sure. In Broward County and elsewhere, many of the mentally ill are better off today than they were in the institutions of yesteryear.

Despite systemic problems, much is being accomplished by scores of dedicated people from the Florida Department of Children & Families, various mental health care providers, Broward County Circuit Court and the Public Defender's Office, and specially trained law enforcement officers from agencies like the Broward Sheriff's Office and the Fort Lauderdale Police Department. They have done their best to make the most of a poorly funded and fragmentary system.

But far too many of the mentally ill are not being served, and have become frequent inmates at the Broward County Jail -- the largest "mental institution" in the county.

Yes, you heard that right. And it's not unusual. The Los Angeles County Jail has been called the largest "mental institution" in the United States. The problem is statewide and nationwide.

Why is this so? Why is the mental health system failing so many people, and failing to fulfill the promise of the deinstitutionalization movement? The answers should matter to every citizen, because the people who aren't being helped are the most seriously ill, the most in need of care -- and the most dangerous.

John Beraglia was a "frequent flier." The term is used by mental health experts and law enforcement personnel to describe people trapped in a vicious circle of mental wards, homelessness or cheap boarding houses -- and jail.

Over a 20-year period until his death in law enforcement custody in 2001, Beraglia was arrested more than 130 times. He spent well over a thousand days in jail, and was committed to South Florida State (Mental) Hospital numerous times.

Most of the charges against Beraglia were relatively minor: trespass, disorderly conduct, indecent exposure, open-container violations, petty theft. But these charges and others like them were repeated over and over again. People in law enforcement and the mental health system who got to know him said Beraglia's only real "crime" was his mental illness.

"John's no criminal; he's just real crazy" is how one law enforcement official put it.

There are thousands of John Beraglias in the mental health and criminal justice systems, not just in Broward County, but in Miami-Dade and Palm Beach counties and throughout Florida and the United States. They are people, according to Howard Finkelstein, Broward's chief assistant public defender, "whose only crime was acting crazy."

But Beraglia was unusual in one important and tragic respect: his mental illness and recidivism eventually cost him his life.

On Sept. 16, 2001, Beraglia died in the mental health unit of the North Broward Detention Facility. Accounts differed as to what happened. The Broward Sheriff's Office said he died after beating his head repeatedly against the wall of his cell, where he was held under a suicide watch. Several other inmates said he was beaten to death by guards, but a grand jury investigation found no wrongdoing and closed the case.

It might have been more accurate, though, if the grand jurors had said that although no individual was guilty of Beraglia's death, the system certainly was.

"John Beraglia died because of our ignorance and our failures to understand how to deal with the mentally ill in the criminal justice system," Finkelstein says.

John deGroot, a mental health policy adviser for the BSO, blames the mental health system and the state's weak commitment to mental health. Says deGroot: "John Beraglia died for our sins."

In 1994, a Broward County grand jury investigation found a mental health system rife with problems and inadequacies, from insufficient funding to lack of leadership and poor integration of services. Since then, the record is mixed. Some improvements have been made, but there are troubling echoes of the 1994 grand jury findings in the mental health system today.

Mental health services remain a crazy-quilt system that depends for its limited success on the extraordinary dedication and resourcefulness of people operating on a fiscal shoestring. It's a creaky old engine that runs largely on the grease of caring, cooperative and pragmatic social workers, judges and police. But they are fighting a losing battle just to keep the engine sputtering along.

Despite their best efforts, and despite the fact that Florida law requires it, the mental health system is not providing a level of care that protects the mentally ill from repeated arrests and incarcerations. This failure hurts the mentally ill and their families, wastes taxpayer money and endangers the public.

Florida, although it is the fourth-largest and third-wealthiest state, is 48th in funding for mental health. Consequently, the mental health system operates by a kind of triage, spending limited resources on those patients it can most help. This essentially writes off the most seriously ill, effectively leaving them to the streets or the criminal justice system, which is ill-equipped to deal with their mental illness. Indeed, it is often said that being in jail can make you crazy if you aren't already.

Experts are in widespread agreement that the deinstitutionalization movement was a good thing in concept. The problem is that the money for an effective system of community-based care to replace institutionalization has not materialized, particularly in Florida. Thus, a system that was intended to improve the lot of the mentally ill now serves as an excuse to deny them treatment.

The result is increased homelessness and more public manifestations of mental illness. These have resulted in the "criminalization of the mentally ill," as they are repeatedly arrested for offenses related to their illnesses. This is inappropriate and unfair, and places a burden on the criminal justice system that should be borne by the mental health system.

The costs to society and the taxpayer of the current system are staggering. Broward County's criminal justice system spends about $65 million a year on arrest, incarceration and court-related services for mentally ill defendants. The Public Defender's Office alone spends more than $2 million a year to defend the rights of the mentally ill in court.

The number of jail inmates with diagnosed mental illness has grown more than five times as fast as the jail's general inmate population. An inmate diagnosed with a serious mental illness costs taxpayers four times as much to incarcerate as a "regular" inmate.

Funding allocations for substance abuse and mental health in the Florida Department of Children & Families have remained essentially flat despite a rapidly growing population. Many mental health "consumers" must take inferior, more toxic, less effective drugs because funding for newer, more effective and more expensive psychotropic medications is lagging. Considering the recidivism costs of the mentally ill and substance-abusing populations, this is penny-wise, pound-foolish.

The shame of deinstitutionalization without adequate funding is that there are improved treatments and medications available today that could allow the mentally ill to live fairly normal lives in the community, as was intended. Mental health experts agree that virtually any mentally ill person can have a reasonably good treatment outcome if he or she can be reached and treated.

The problem is that not enough are being reached, and many of those who are being reached are not being treated effectively. All too often they end up in the jail, which, although it is fully accredited to provide health services, "is not the place for someone to get better," says Dr. Timothy Ludwig, the BSO's mental health coordinator.

Everyone involved in the system knows what works. They just can't always do it for lack of funding.

Funding crises are only getting worse as the state and nation wrestle with the consequences of the economy's recent struggles, unwise tax policies and diminished revenue streams. But considering the costs to society of not adequately dealing with the mentally ill, better funding should be seen less as a cost than as an investment.

As Finkelstein says, "the test for the next decade will be to figure out how to deal with the mentally ill in the criminal justice system," and to decide whether it's better to pay for appropriate treatment at the front end rather than after they've been arrested, because then "the cost includes the blood and the bones of innocent people."

More funding alone won't fix the system. There must also be less fragmentation, better coordination of services and more accountability. Even then, the state must do a better job of persuading, and in some cases gently coercing, the mentally ill to seek and accept the treatment options and pharmaceutical therapies available to them.